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Remote Claims Processor Jobs in Maine (NOW HIRING)

Sun Life Financial

Stop Loss Claims Resolution Consultant

Portland, ME · Remote

$67K - $87K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Claims Resolution Consultant serves as a subject matter expert in Stop Loss medical claims and ... Identify opportunities for process improvements, enhanced job aids, or clearer communication ...

Sun Life Financial

Stop Loss Claims Resolution Consultant

Portland, ME · Remote

$67K - $87K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Claims Resolution Consultant serves as a subject matter expert in Stop Loss medical claims and ... Identify opportunities for process improvements, enhanced job aids, or clearer communication ...

Crawford & Company - América Latina

Property Adj

Portland, ME · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Drive Success in Property Claims - Join Our Team in Portland, Maine! Position: Property Adjuster Location: Portland, ME (Hybrid: Work From Home + Driving Role) What We're Looking For: Minimum 2 years ...

Crawford and Company

Property Adj

Portland, ME · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Drive Success in Property Claims - Join Our Team in Portland, Maine! Position: Property Adjuster Location: Portland, ME (Hybrid: Work From Home + Driving Role) What We're Looking For: Minimum 2 years ...

Gallagher

Personal Lines Client Service Manager

Portland, ME · Remote

$39K - $53K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

While this role is not currently open, it is fully remote, and we welcome the opportunity to ... About You Required: Bachelor's degree with 0+ years client service and/or claims management ...

Milliman

Strategic Data Partnership Manager

Portland, ME · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This position is fully remote, while occasional travel may be required. Primary Responsibilities ... Enjoy building processes and playbooks rather than simply following established ones. * View ...

Nourish

RCM Lead

Portland, ME · Remote

This role is full-time and fully remote (with option to work from our NYC office). Key ... processing insurance coverage verifications. * Work claims end-to-end via our clearinghouse and ...

Nourish

Senior RCM Associate

Portland, ME · Remote

This role is full-time and fully remote (with option to work from our NYC office). Key ... processing insurance coverage verifications. * Work claims end-to-end via our clearinghouse and ...

Norstella

Legal Counsel, Employment

Augusta, ME · Remote

Remote, United States Date Posted: Jun 2, 2026 Employment Type: Full Time Job ID: R-1980 ... S. and international jurisdictions, including employment claims and grievances, wage and hour ...

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Remote Claims Processor information

See Maine salary details

$11

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How much do remote claims processor jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for remote claims processor in Maine is $18.56, according to ZipRecruiter salary data. Most workers in this role earn between $15.82 and $20.00 per hour, depending on experience, location, and employer.

What does a remote claims processor do?

The job duties of a remote claims processor revolve around working to process insurance claims. You typically work from home or another remote location. Your responsibilities start with assessing the claimant's insurance policy and coverage. You review documents and records related to the claim and decide on approval or denial of the claim. A processor also prepares the paperwork necessary for the insurer to process the case for the client. You also have customer service duties, such as answering patient questions and telling them about the claim status. Processors can work with medical insurance, property insurance, or casualty insurance.

What does a remote claims processor do?

A Remote Claims Processor reviews, evaluates, and processes insurance claims from a remote location, typically working from home. They verify information, assess documentation, and determine the validity of claims for insurance companies or healthcare providers. This role requires attention to detail, knowledge of insurance policies, and the ability to communicate with clients or providers to resolve discrepancies. Remote Claims Processors use specialized software to manage claims efficiently and ensure compliance with industry regulations.

What are the key skills and qualifications needed to thrive as a remote claims processor, and why are they important?

To thrive as a Remote Claims Processor, you need strong attention to detail, analytical skills, and a solid understanding of insurance policies, often supported by a high school diploma or relevant experience. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent written communication, time management, and problem-solving abilities help you stand out in this role. These skills ensure accurate and efficient claims handling, customer satisfaction, and compliance with regulatory standards in a remote work environment.

What are some common challenges faced by remote claims processors, and how can they be addressed?

Remote Claims Processors often encounter challenges such as managing high volumes of claims, maintaining accuracy without in-person supervision, and communicating effectively with team members across different locations. To address these, it's essential to develop strong organizational skills, utilize digital tools for tracking and documentation, and participate actively in virtual team meetings. Proactively seeking feedback and staying updated on policy changes can also enhance efficiency and reduce errors in a remote setting.

What is the difference between Remote Claims Processor vs Remote Claims Examiner?

AspectRemote Claims ProcessorRemote Claims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or claims processing certificationsHigh school diploma or equivalent; often requires licensing or certification in insurance claims examination
Work EnvironmentHome-based or remote office; primarily computer and phone workHome-based or remote; involves reviewing and analyzing insurance claims
Industry UsageInsurance, healthcare, government agenciesInsurance companies, healthcare providers, government agencies
Common Search/ComparisonYesYes

Remote Claims Processors and Remote Claims Examiners both work in the insurance industry, often remotely, handling claims. While both roles require similar credentials and work environments, Claims Examiners typically perform more detailed analysis and may require specific licensing. Understanding these differences helps job seekers identify the right position based on their skills and certifications.

More about Remote Claims Processor jobs

What are popular job titles related to Remote Claims Processor jobs in Maine?

For Remote Claims Processor jobs in Maine, the most frequently searched job titles are:

What job categories do people searching Remote Claims Processor jobs in Maine look for?

The top searched job categories for Remote Claims Processor jobs in Maine are:

Remote Claims Processor jobs near you
Infographic showing various Remote Claims Processor job openings in Maine as of August 2026, with employment types broken down into 1% Internship, 83% Full Time, 11% Part Time, 3% Temporary, and 2% Contract. Highlights an 82% Physical, 5% Hybrid, and 13% Remote job distribution, with an average salary of $38,596 per year, or $18.6 per hour.

Senior Director, Claims & Payment Integrity - Remote

Martin's Point Health Care

Portland, ME • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 12 days ago

Martin’s Point Health Care rating

7.4

Company rating: 7.4 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Senior Director, Claims & Payment Integrity, is responsible for oversight of health plan claims administration and payment integrity functions. The position will develop, maintain, and optimize process flows to maintain claims payment accuracy.
Job Description
Key Outcomes:
  • Drives quality, timely claims processing to allow the health plan to achieve regulatory compliance, robust financial management and product strategy outcomes
  • Oversee strong inventory management processes and enhance auto adjudication
  • Delivers strong vendor oversight to optimize system processing to improve efficiency and accuracy; pursue new vendor opportunities including Request for Information (RFI)/Request for Proposal (RFP) as deemed appropriate
  • Collaborates with business and IT teams to ensure system and operational readiness for system fixes, configuration, and project rollouts impacting claims processing
  • Ensures operational readiness, testing, training, reporting, and communications are in place for claims processing updates
  • Acts as business owner for claims processing and edit vendors, ensuring oversight of vendor, including day-to-day management, roadmap reviews and joint operating committee management
  • Oversees, develops, and maintains documentation for claims and configuration processes and procedures with appropriate controls, reporting and quality assurance
  • Develops work intake mechanisms, exploring and implementing tools to manage claims processing tickets, prioritize backlog and assess different work types (i.e., reporting, configuration, project vs. production fixes, etc.)
  • Remains up to date on industry trends and advancements in claims provider reimbursement and system technology to identify opportunities for improvement
  • Supports regular audits and quality checks to ensure data accuracy and system performance
  • Oversees the research, development, implementation, ongoing operational maintenance and administration of provider payment methodologies and fee schedules for all provider types in support of provider contractual arrangements
  • Supports the development and integration of provider payment policies and guidelines applicable to institutional and professional reimbursements and in concert with the Organization's products and member benefits
  • Maintains all institutional and professional reimbursement methodologies leveraged by the organization. This includes demonstrating deep knowledge in industry standard payment methods
  • Demonstrates working knowledge in the design and roll out of alternative payment methods that are focused on an incentive-based pay for value approach. This will require partnering cross organizationally to support the development of these new programs, and direct the operational activities necessary to stand them up
  • Researches and provides recommendations on development of new or enhancements to existing reimbursements in conjunction with corporate and contractual initiatives including sound financial modeling/impact analyses

Education/Experience:
  • Bachelor's degree required; Master's in business administration or comparable advanced degree strongly preferred
  • CPC Preferred
  • 10+ years health plan management experience required
  • Experience managing vended system applications
  • Experience with test plan development, strategy, and execution

Skills/Knowledge/Competencies (Behaviors):
  • Demonstrates an understanding of and alignment with Martin's Point Values.
  • Maintains knowledge and understanding of reimbursement agreements as well as claims and billing practices that impact cost and utilization data.
  • Detailed knowledge of applicable regulatory and accrediting body standards (National Committee of Quality Assurance (NCQA), Centers of Medicare and Medicaid Services (CMS))
  • Develops and maintains positive, effective working relationships with colleagues, vendors, and other internal and external customers.
  • Excellent workflow and inventory management skills.
  • Excellent problem solving, quantitative and analytical skills with the ability to assess performance against metrics.
  • In-depth technical knowledge and ability to learn new technologies; knowledge of the Software Development Life Cycle (SDLC).
  • Ability to manage, organize, and prioritize workload in a timely accurate manner.
  • Ability to manage multiple competing demands and function independently.
  • Knowledge of industry standards for claims and enrollment configuration, reporting and analysis.
  • Knowledge of benefit coverage and servicing members, providers, and the DoD, CMS/ Medicare Advantage, and ME state insurance coverage.
  • Knowledge of managed care computer systems, features, and reporting.
  • Demonstrated interpersonal, communications, operational, team building, and quality improvement skills.
  • Critical thinking: can identify root causes and implement short- and long-term sustainable solutions.

There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
Pay Range:$165,546.85 - $204,499.05The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan.In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org
Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

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